Enough saw palmetto prostate benefits have been seen in research for men consider using this supplement for natural treatment of symptoms associated with benign prostate gland enlargement (called benign prostatic hyperplasia, or BPH). Saw palmetto (Serenoa repens or Sabal serrulata) is a dwarf palm plant with berries native to the southeastern US which may have prostate benefits in improvement of urinary symptoms associated with prostate enlargement. Saw palmetto has some potential adverse effects that the healthcare provider should be aware of. The latest and strongest evidence based uses for Saw Palmetto are included below.
An overview of Saw Palmetto effectiveness and dosage:
Saw palmetto prostate benefits were seen in an overview by Neelima Dhingra and Deepak Bhagwat. The authors found that treatment with saw palmetto found that 160 mg of this agent taken 2 times per day for 1 to 3 months was shown to be beneficial over placebo for improving symptoms of enlarged prostate (benign prostatic hyperplasia or BPH). S. repens is different than prescription medications for BPH in that it does not cause impotence, and has no effect on prostate size or the prostate-specific antigen test. (1)
Standardized Saw Palmetto extract preparation vs. finasteride:
In a double-blind study, researchers randomized 1098 men with benign prostatic hyperplasia (BPH) to either plant extract Permixon (320 mg) (also known as Saw Palmetto, Sabal serrulata and Serenoa repens), or finasteride (5 mg) and monitored them for 6 months. According to the results, the two treatments were about equally successful at reducing noticeable symptoms (37% with Permixon and 39% with finasteride). Peak urinary flow rate increased by 3.2 mL/sec (25%) and 2.7 mL/sec (30%) for the 2 groups, respectively. Permixon had little effect on prostate size (6% reduction in size), whereas finasteride caused the prostate to shrink by 18%. Finasteride also reduced prostate-specific antigen (PSA) levels by 41%. (2)
Saw Palmetto extract, BPH symptoms, prostate size, and urine flow:
Saw palmetto prostate benefits were seen in a study which followed 26 men with enlarged prostates. The men received a daily dose of 320 mg Permixon twice a day taken before a meal with water (also known as Saw Palmetto, Sabal serrulata and Serenoa repens). Results show Permixon reduced symptoms (measured using the international prostate symptom score) by 76% and improved quality of life by 53.3% from baseline. The average international prostate symptom score (IPSS) was reduced by 8.8 or 76% from baseline. Permixon caused men’s prostates to shrink by 29.8%. On average, peak urinary flow rate increased by 4.13 mL/sec (35%). Improvements in symptoms and quality of life were maintained during the entire five year study. (3)
Saw Palmetto extract, urinary flow and post-void urine volume:
Sabal extract IDS 89, (also known as Saw Palmetto, Sabal serrulata and Serenoa repens) improves symptoms of men suffering from enlarged prostate. A total of 435 men were included in this 3-year prospective study that reported a 50% reduction in residual urine and a 6.1 ml/sec increase in peak urinary flow rate due to IDS 89. The effectiveness of IDS 89 was reported to be ‘good’ or ‘very good’ in over 80% of cases. Additionally, disease progression at the end of 3-years was significantly lower among patients taking IDS 89 compared to those not treated. No major side-effects were reported. (4)
Saw Palmetto extract, urinary flow, and nocturia:
Researchers reviewed 13 studies (n= 2859), eleven of which were randomized, and seven placebo controlled to examine the effect of Permixon (also known as Saw Palmetto, Sabal serrulata and Serenoa repens) in the treatment of symptomatic benign prostatic hyperplasia (BPH), enlarged prostate. Results show a mean increase in urinary maximum flow rate with placebo was 0.6 ml/second, and there was an additional 2 mL/second with Permixon. The mean number of decreased episodes of night urination (nocturia) was 0.6 episodes with placebo and an additional 0.5 episodes with Permixon. In conclusion, Permixon showed how saw palmetto prostate benefits can be superior to placebo in increasing peak urine flow rate and reducing nocturia. (5)
A review including 18 trials (n=2939) found that Serenoa repens (S. repens), extracted from saw palmetto, was superior to placebo in increasing peak urine flow rate and reducing night-time urination (nocturia) in men with benign prostatic hyperplasia (BPH), enlarged prostrate. S. repens decreased nocturia by 0.76 times per night and increased peak urine flow by 1.93 ml/s. Men on S. repens treated reported a 72% greater improvement of their urinary tract symptoms versus men taking placebo. (6)
Saw Palmetto extract vs. tamsulosin, and ejaculation disorders:
Saw palmetto prostate benefits were evaluated by Debruyne and colleagues. The authors demonstrated that Permixon (Serenoa repens) and tamsulosin (alpha-blocker) were equivalent in terms of improvements in Internation Prostrate Symptom Score (IPSS). There was also improvement seen in maximum urinary flow rate (Qmax) in the treatment of lower urinary tract symptom in men with benign prostatic hyperplasia (BPH) or enlarged prostrate, during and up to 12 months of the therapy. At 12 months, I-PSS decreased by 4.4 in each group and the increase in Qmax was similar at 1.8 ml/s Permixon and 1.9 ml/s tamsulosin. Both compounds were well tolerated; however, ejaculation disorders occurred more frequently in the tamsulosin group. (7)
All studies did not show Saw palmetto prostate benefits
Saw palmetto prostate benefits were not always seen in research. Saw palmetto was reported to have no effect on the symptoms of benign prostatic hyperplasia (BPH) or enlarged prostrate in this double-blind study that included 225 men aged 49 years and older with moderate-to-severe symptoms of BPH. Participants were randomly assigned to receive saw palmetto extract (160 mg twice a day) or placebo for an entire year. At the end of the study, no significant differences in the change in scores on the American Urological Association Symptom Index (AUASI), maximal urinary flow rate, prostate size, residual volume, quality of life, or serum prostate-specific antigen levels were reported between the treatment group and placebo group. (8)
Saw palmetto adverse reactions, interactions:
Saw palmetto vs. placebo: In the study mentioned above by Champault, et al, less adverse effects were reported by the treatment group than the placebo group (5 vs 11 instances) and were minor such as headache (9).
A case report of Saw palmetto and bleeding: A case report showed that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto. (10)
Saw Palmetto and blood clotting: Saw palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect. Consumption should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding. (11)
Summary: Saw Palmetto
- In most studies, Saw palmetto, (a.k.a. Sabal serrulata and Serenoa repens or Permixon brand name) improved urine flow rate, reduced nocturnal urination, was comparable to finasteride, and in some studies reduced enlarged prostate size associated with BPH. Prostate specific antigen (PSA) levels were not reduced by this herbal treatment. The most common dosage studied in research was 160 mg oral twice per day.
- Permixon, Saw Palmetto, (a.k.a. Sabal serrulata and Serenoa repens) was associated with few adverse effects and no sexual side effects in the majority of studies. In a study comparing Saw Palmetto extract with tamsulosin, ejaculation disorders occurred less frequently with saw Palmetto (7). One study of 94 patients noted less adverse effects by the treatment group than the placebo group and were minor such as headache (17). A case report showed that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto (18). Saw Palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect and should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding (19). It is important to discontinue saw palmetto 2 weeks prior to any invasive dental procedures or surgery.
- Pharmaceutical agents compared to saw palmetto in studies include Proscar (finasteride) which reduced PSA levels but caused erectile dysfunction, reduced ejaculation volume, and in some cases irreversible erectile dysfunction. Flomax (tamulosin) caused low blood pressure, dizziness, and retrograde ejaculation.
- Adverse effects associated with Saw palmetto use may include mild stomach pain, constipation, diarrhea, nausea, and vomiting. Saw palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect. Consumption should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding (11). A case report outlined that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto (10). Less adverse effects were reported by Champault, et al the treatment group than the placebo group (5 vs 11 instances) and were minor such as headache (9).
References for Saw Palmetto Prostate Benefits
1.Neelima Dhingra and Deepak Bhagwat. Benign prostatic hyperplasia: An overview of existing treatment. Indian J Pharmacol. 2011 February; 43(1): 6–12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062123/
2.Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostatic hyperplasia: a randomized international study of 1098 patients. Prostate. 1996 Oct;29(4):231-240. http://www.ncbi.nlm.nih.gov/pubmed/8876706
3.Aliaev IuG, Vinarov AZ, Lokshin KL, Spivak LG. [Five-year experience in treating patients with prostatic hyperplasia patients with permixone]. [Article in Russian]. Urologiia. 2002 Jan-Feb;(1):23-5. http://www.ncbi.nlm.nih.gov/pubmed/11877967
4.Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia – results of a prospective 3-year multicenter study using Sabal extract IDS 89. Phytomedicine. 1996 Sep;3(2):105-11. http://www.ncbi.nlm.nih.gov/pubmed/23194957
5.P Boyle et al. Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia. Urology 2000 55: 533-539. http://www.ncbi.nlm.nih.gov/pubmed/10736497
6.Wilt TJ, Ishani A, Rutks I, et al. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000 Dec;3(4A):459-72. http://www.ncbi.nlm.nih.gov/pubmed/11276294
7.Debruyne F, Koch G, Boyle P, et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Prog Urol. 2002 June;12(3):384–394. http://www.ncbi.nlm.nih.gov/pubmed/12189744
8.Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006 Feb 9;354(6):557-66. http://www.ncbi.nlm.nih.gov/pubmed/16467543
9.Champault, G., Patel, J. C., and Bonnard, A. M. A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br J Clin Pharmacol. 1984;18(3):461-462. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463641/pdf/brjclinpharm00156-0149.pdf
10.Cheema, P., El Mefty, O., and Jazieh, A. R. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med 2001;250(2):167-169. http://www.ncbi.nlm.nih.gov/pubmed/11489067
11.Agency for Healthcare Research and Quality. Comparative Effectiveness of Dietary Supplement Versus No Dietary Supplement Use in Adults Taking Cardiovascular Drugs. April 2012. http://www.effectivehealthcare.ahrq.gov/ehc/products/223/596/DietarySupplement_Amended_Protocol_20110428.pdf